Provider Demographics
NPI:1902932387
Name:SHEPPERSON, MARY THERESE (RPH)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:THERESE
Last Name:SHEPPERSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3474 RICHARDS RUN
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-5800
Mailing Address - Country:US
Mailing Address - Phone:804-598-1699
Mailing Address - Fax:
Practice Address - Street 1:2511 ANDERSON HWY
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-7508
Practice Address - Country:US
Practice Address - Phone:804-598-5028
Practice Address - Fax:804-598-6117
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201006905183500000X
VA0202006905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist